Provider Demographics
NPI:1720220130
Name:TISCARENO, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:TISCARENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 IRVINGTON PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2319
Mailing Address - Country:US
Mailing Address - Phone:323-534-3761
Mailing Address - Fax:
Practice Address - Street 1:5601 E SLAUSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2997
Practice Address - Country:US
Practice Address - Phone:213-216-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator